Number of teeth is independently associated with ischemic stroke: A case-control study.

Poor oral health has been suggested as a potential risk factor for the occurrence of cardiovascular events. The present study aimed to test the hypothesis that the number of permanent natural teeth (NT) is independently associated with the occurrence of ischemic stroke (IS) or transient ischemic attack (TIA) in a southern Brazilian population. This case-control study enrolled 458 subjects, 229 hospital patients diagnosed with IS or TIA (cases) and 229 patients with no history of cardiovascular disease (controls). NT was assessed through a head and neck multidetector computed tomography angiography (MDCTA) and panoramic radiographs. The participants were matched by age and sex. Sociodemographic and medical confounding variables were obtained from the hospital charts and through a structured questionnaire. Multivariate logistic regression analysis were carried out to estimate the association between NT and the occurrence of IS or TIA. The mean age was 58.37 ± 10.75 years, with 46.7% males. Adjusted analyses showed an independent association between IS or TIA and hypertension (OR = 6.34, 95%CI = 3.93-10.24), smoking (OR = 4.70, 95%CI = 2.76-7.99) and NT (lower quartile: ≤7 teeth) (OR = 5.59, 95%CI = 2.88-10.86). The number of permanent natural teeth was inversely and independently associated with the occurrence of IS or TIA in this population. Present findings suggest a gradient effect on the association between oral health and IS.

Tooth loss is associated with atherosclerosis and a poorer functional outcome among stroke patients.

OBJECTIVES: The purpose of the study was twofold: (1) to test the hypothesis that tooth loss is independently associated with carotid atherosclerotic burden (CAB) among individuals with ischemic stroke (IS) or transient ischemic attack (TIA) and (2) to test the association between tooth loss and disability following the occurrence of cerebral ischemia. MATERIALS AND METHODS: This observational study included 418 patients with IS or TIA. Tooth loss and the CAB were measured through a head and neck multidetector computed tomography angiography. CAB was analyzed in both common, internal, and external carotid arteries and classified in five levels of vascular occlusion. The modified Rankin Scale (mRS) was used to evaluate the functional outcome at patient discharge. Health records provided information on sociodemographic and medical covariates. The association between CAB and tooth loss, as well as between tooth loss and subtypes of cerebral ischemia were estimated through Poisson regression. Cox regression was carried out to evaluate the association between tooth loss and the mRS, with α = 5%. RESULTS: Mean age was 65.6 ± 13.8 years, with 52.4% males. Multivariate analyses revealed that severe tooth loss (> 23 missing teeth) was independently associated with CAB ≥ 50% (PR = 2.86, 95% CI = 1.19-6.89) and mRS scores (> 2) (HR = 1.97, 95% CI = 1.10-3.75). CONCLUSION: Tooth loss was independently associated with CAB and predicted a poorer functional outcome among IS and TIA patients. CLINICAL RELEVANCE: Clinical assessment of tooth loss may provide important information on risk for CAB and poorer functional outcome among stroke patients.

Infrared lasers for the treatment of moderate to severe periodontitis: An American Academy of Periodontology best evidence review.

BACKGROUND: This systematic review assesses the efficacy of infrared laser therapy used alone or as an adjunct to nonsurgical or surgical periodontal therapy, on clinical and patient-centered outcomes in patients with periodontitis. METHODS: Randomized clinical trials (RCTs) with a follow-up duration ≥3 months that evaluated root surface debridement (i.e., scaling and root debridement with or without surgical access) to laser therapy alone or laser therapy plus root surface debridement for the treatment of adult patients (≥18 years old) with moderate to severe aggressive or chronic periodontitis were considered eligible for inclusion. The MEDLINE, EMBASE and CENTRAL databases were searched for articles published up to and including March 2016. Random effects meta-analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences (MDs) with their associated 95% confidence intervals (CIs). Additionally, summaries are presented of the included RCTs, critical remarks of the literature and evidence quality rating/strength of recommendation of laser procedures. RESULTS: Of the 475 potentially eligible articles, 28 were included in the review. Individual study outcomes and seven sets of meta-analysis (1 for the nonsurgical treatment of AgP and 9 for nonsurgical and surgical treatment of CP) showed a benefit of laser therapy in improving clinical attachment level (CAL) and probing depth (PD). However, the comparative differences in clinical outcomes were modest (< 1 mm) and the level of certainty for different therapies was considered low-to-moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the Strength of Clinical Recommendations of laser therapies were considered weak or based on expert opinion. CONCLUSIONS: In patients with moderate to severe periodontitis, the nonsurgical treatment of AgP and CP by SRP plus infrared diode laser, and the surgical treatment of CP by Er:YAG laser therapy alone may promote statistically significant improvements in PD and CAL. However, these gains are relatively small (< 1 mm) and provide modest clinical relevance compared with SRP alone.

Validity of self-reported history of endodontic treatment in the Baltimore Longitudinal Study of Aging.

INTRODUCTION: Self-reported history of endodontic treatment (SRHET) has been used as a simplified method to estimate the history of endodontic disease and treatment. This study aimed to quantify the validity of SRHET, as reported in the Baltimore Longitudinal Study of Aging (BLSA), as a method to identify individuals who experienced endodontic treatment (ET) and to identify individuals who present with apical periodontitis (AP). METHODS: SRHET was collected through the BLSA questionnaire in 247 participants. Data on ET and AP were determined from panoramic radiographs. The total number of ET, AP, and missing teeth were recorded for each individual. The validity of SRHET was determined based on ET and AP separately. Accuracy, efficiency, sensitivity, specificity, positive and negative predictive values (+PV and -PV), and positive and negative likelihood ratios (+LR and -LR) were calculated according to standard methods. RESULTS: After exclusions, 229 participants were available for ET analysis and 129 for AP analysis. The SRHET validity values were sensitivity (ET = 0.915, AP = 0.782), specificity (ET = 0.891, AP = 0.689), +PV (ET = 0.824, AP = 0.353), -PV (ET = 0.949, AP = 0.936), +LR (ET = 8.394, AP = 2.514), and -LR (ET = 0.095, AP = 0.316). CONCLUSIONS: SRHET was found to be a highly accurate method to predict ET but a weak predictor of the presence of AP among participants in the BLSA.

Biomarkers predictive of lymph node metastases in oral squamous cell carcinoma.

PURPOSE: The ability of oral squamous cell carcinoma to metastasize to lymph nodes does not always show a relationship with clinical staging. The aim of this study was to attempt to define a trend for predictive histopathologic and/or molecular biomarkers in the development of nodal metastasis by analyzing 2 clinically extreme groups. PATIENTS AND METHODS: Patients with small primary tumors (T1, T2) with lymph node metastasis and patients with large primary tumors (T3, T4) without metastatic disease were identified among 315 consecutive cases of primary oral squamous cell carcinoma. Group comparisons were made with use of a Mann-Whitney test, and associations among the variables were assessed with nonparametric and parametric correlational analyses. RESULTS: The degree of keratinization was significantly less in primary tumors with lymph node metastasis (P < or = .01). The degree of keratinization was significantly associated with nuclear pleomorphism (P =.02), number of mitoses (P =.02), stage of invasion (P =.002), and p53 expression (P =.04), independent of clinical stage of the tumor. Other microscopic features and immunohistochemical markers did not differ significantly between the groups (P >.05). CONCLUSION: These data indicate that there still is no single predictive parameter superior to the degree of keratinization to identify patients at risk for the development of regional metastasis.